Healthcare Provider Details

I. General information

NPI: 1437683067
Provider Name (Legal Business Name): JORDAN THOMAS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 CASSIDY ST
OCEANSIDE CA
92054-6033
US

IV. Provider business mailing address

303 AMHERST ST
NASHUA NH
03063-1722
US

V. Phone/Fax

Practice location:
  • Phone: 442-222-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04304
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: